Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2012
Mediated interruptions of anaesthesia providers using predictions of workload from anaesthesia information management system data.
Perioperative interruptions generated electronically from anaesthesia information management systems (AIMS) can provide useful feedback, but may adversely affect task performance if distractions occur at inopportune moments. Ideally such interruptions would occur only at times when their impact would be minimal. In this study of AIMS data, we evaluated the times of comments, drugs, fluids and periodic assessments (e.g. electrocardiogram diagnosis and train-of-four) to develop recommendations for the timing of interruptions during the intraoperative period. ⋯ Timing was minimally affected by the type of anaesthesia, surgical facility, surgical service, prone positioning or scheduled case duration. The implication of our results is that for mediated interruptions, waiting at least 13 minutes after the start of surgery is appropriate. Although we used AIMS data, operating room information system data is also suitable.
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Anaesth Intensive Care · Sep 2012
Stroke volume variation as a predictor of fluid responsiveness in patients undergoing airway pressure release ventilation.
We investigated the effectiveness of stroke volume variation (SVV) shown by the Vigileo-FloTrac™ system (Edwards Lifesciences, Irvine, CA) to predict fluid responsiveness in patients undergoing airway pressure release ventilation (APRV). All 80 patients mechanically ventilated in the intensive care unit of our hospital from April to November 2010 were included in this study. After starting APRV, Ringer's lactate solution was administered for 30 minutes. ⋯ The areas under the ROC curves were 0.793 for SVV (95% confidence interval: 0.709-0.877) and 0.442 for central venous pressure (95% confidence interval: 0.336-0.549), which were significantly different (P<0.05). The optimal threshold value of SVV to discriminate between responders and nonresponders was 14% (sensitivity: 78.9%; specificity: 64.3%). We found that SVV was able to predict fluid responsiveness in patients undergoing APRV with acceptable levels of sensitivity and specificity.
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Anaesth Intensive Care · Sep 2012
Case ReportsContribution of morphine and morphine-6-glucuronide to respiratory depression in a child.
A morphine plasma concentration/respiratory rate relationship has been described for both adults and children although that of its metabolite, morphine-6-glucuronide, remains uncertain. We describe this relationship in a child with end-stage renal failure who received repeat morphine administration over two days. ⋯ Failure to clear morphine-6-glucuronide renally led to respiratory depression episodes occurring later than those predicted by modelling morphine levels only. These findings support the use of alternative analgesics (e.g. fentanyl) that are cleared by non-renal pathways and have no active metabolites in patients with end-stage renal disease.
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Anaesth Intensive Care · Sep 2012
Enhanced Needle Visualization: advantages and indications of an ultrasound software package.
The ultrasound software package Enhanced Needle Visualization (ENV) has been reported to provide improved ultrasound imaging of needles even at steep insertion angles. ENV has three settings: shallow, medium and steep. However, the angles are unknown. ⋯ At 60 degrees the objective visibility was 'not visible' in the off position and significantly increased to 'poor' in the steep setting. We recommend selecting the shallow setting for needles with an insertion angle of 30 degrees and the steep setting for 45 degrees within the advantageous area. This technique may allow safer ultrasound procedures for various unprecedented approaches.